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General NPI Number Information
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NPI Number | 1891790390
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Entity Type | Organization
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Legal Business Name | J.D. DE LORME, D.D.S., INC
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 26302 LA PAZ RD STE 114
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City | MISSION VIEJO
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State | CA
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Zip | 92691-5327
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Country | US
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Telephone | 949-581-5800
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Fax | 949-581-6794
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Provider Business Mailing Address
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Address Line | 26302 LA PAZ RD STE 114
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City | MISSION VIEJO
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State | CA
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Zip | 92691-5327
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Country | US
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Telephone | 949-581-5800
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Fax | 949-581-6794
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JOHN DENNIS DE LORME JR.
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Credential | D.D.S.
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Telephone | 949-581-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | O-118872-L
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License Number State | CA
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